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Healthcare Reform Next Steps

With Supreme Court ruling out of the way, companies can focus on preparing for coming changes.

The Supreme Court’s decision affirming the constitutionality of U.S. healthcare reform removes much uncertainty and clears the way for employers to prepare for various requirements of the law that take effect next year and in 2014.

Some uncertainty still exists. In response to the Supreme Court’s decision, Mitt Romney and Republican congressional leaders promised to overturn healthcare reform, making it clear the law will be a major issue in the November elections.

“There’s no question that this is an issue that will be amplified in the months between now and November,” says Paul Dennett, senior vice president of health care reform at the American Benefits Council. “Really it moves from a decision by nine members of the court to the American voter to decide what happens next.”

The GOP would have to win the White House and majorities in both houses of Congress in order to overturn the law, Dennett says.

For companies, the next step is clear: getting set for the changes required under the PPACA.

“Those employers that have been reluctant to move forward with implementing those reforms until the court ruling will now have to move forward,” says Amy Bergner, a partner in HR consulting firm Mercer's Washington resource group. “A tremendous amount of new mandates are taking effect in 2014 and there’s a lot of planning and strategizing that needs to be done.”

Of course, many companies have been making preparations all along. Consultants say employers are in good shape when it comes to near-term changes, which include the requirement to report the value of the health coverage the company provides on employees’ W-2 forms, a change that will show up on the 2012 W-2s companies hand out next year. And in 2013, companies must provide new summaries of benefits to employees and put in place a cap on the amount employees can contribute to healthcare flexible spending accounts.

There’s more concern about requirements that kick in 2014 and later years, in part because regulators have yet to provide guidelines on many points.

“For 2014 provisions and any effective beyond that, we have no guidance at all,” says the American Benefit Council’s Dennett, pictured at right. “We have some pre-regulatory guidance in the form of bulletins that provide a range of possible options that the agencies have asked for comments on, but nothing that’s moved to the rulemaking stage.”

While that’s not a problem for companies whose employees work regular hours, other companies have many part-timers or employees with flexible schedules, he says. “To create their strategy for meeting that mandate, they need more guidance—that’s a pretty significant need.”

In 2014, companies also face the requirement that their healthcare coverage meets a minimum value test. “That’s another key design consideration companies have to work on that they don’t have guidance on,” says Mercer’s Bergner.

Farther down the line, companies will have to begin auto-enrolling employees who fail to make a decision about health insurance into the plan. Dennett says the government recently announced that rulemaking on this point won’t be complete until 2014, so the requirement isn’t likely to take effect until 2015 at the earliest.

PPACA also mandates that states set up healthcare exchanges where unemployed people and workers at smaller companies can obtain coverage. A number of states have held off on setting up their exchange as they waited for the Supreme Court’s decision.

Pat Haraden, a principal in the employee benefits consulting firm Longfellow Benefits in Boston, notes that by Jan. 1, 2013, states have to certify to the Health and Human Services Department that their exchange will be up and running by the start of 2014. “We expect only a few states will be ready to certify by then that they’ll be ready in a year,” he says. “That will cause issues, because if the mandate [for universal coverage] is still Jan. 1, 2014, there won’t be any place for these people to go to buy insurance. Our sense is the mandate will be delayed somewhat.”

The federal government has said it will provide an exchange if states are unready or unwilling to do so. But Haraden questions whether the federal government will be ready to step in and provide an exchange for states that aren’t ready themselves.

Dennett says the state exchanges aren’t an issue for most large employers, because they will continue to provide coverage to their employees. For big companies that do deal with the state exchanges, the situation is likely to be complicated, he says, with each state exchange set up differently, and exchanges run by the federal government set up differently as well. Dennett notes that some states may even provide only limited services themselves and let the federal government do the rest, an approach the Health and Human Services Department has said is allowed.

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